<!DOCTYPE html>
<html lang="ja">

<head>
    <meta charset="UTF-8">
    <title>お支払口座登録・変更</title>
    <link rel="stylesheet" href="/css/all.css">
</head>

<body>
<div class="header">
    <div>
        <a href="#">カードサイト</a>
        <a href="#">お手続き</a>
        <a href="#">お問い合わせ</a>
        <a href="#">会員ログイン</a>
    </div>
</div>

<hr>
<div class="title-bar container0">お支払口座登録・変更情報のご入力</div>
<div class="container">
    <hr>


    <!-- 添加表单标签 -->
    <form action="/apply/biangeng02" method="post" th:object="${app}">

        <!-- 金融機関名字段 -->
        <div class="form-group">
            <div class="label">金融機関名<span><img src="/images/icon_required.png" alt=""></span></div>
            <div class="input-group">
                <div class="radio-group">
                    <div class="radio-option">
                        <input type="radio" id="method1" name="bankcd" value="0001"
                               th:field="*{bankcd}"
                               class="radio-button" required>
                        <label for="method1" class="radio-label">三菱ＵＦＪ銀行</label>
                    </div>
                    <div class="radio-option">
                        <input type="radio" id="method2" name="bankcd" value="0005"
                               th:field="*{bankcd}"
                               class="radio-button" required>
                        <label for="method2" class="radio-label">三井住友銀行</label>
                    </div>
                    <div class="radio-option">
                        <input type="radio" id="method3" name="bankcd" value="0009"
                               th:field="*{bankcd}"
                               class="radio-button" required>
                        <label for="method3" class="radio-label">みずほ銀行</label>
                    </div>
                    <div class="radio-option">
                        <input type="radio" id="method4" name="bankcd" value="0010"
                               th:field="*{bankcd}"
                               class="radio-button" required>
                        <label for="method4" class="radio-label">埼玉りそな銀行</label>
                    </div>
                    <div class="radio-option">
                        <input type="radio" id="method5" name="bankcd" value="0017"
                               th:field="*{bankcd}"
                               class="radio-button" required>
                        <label for="method5" class="radio-label">三菱FinBank</label>
                    </div>
                </div>
                <div th:if="${#fields.hasErrors('bankcd')}" style="color: red; font-size: 14px; margin-top: 5px;">
                    <span th:errors="*{bankcd}"></span>
                </div>
            </div>
        </div>

        <!-- 支店・出張所コード字段 -->
        <div class="form-group">
            <div class="label">支店・出張所コード<span><img src="/images/icon_required.png" alt=""></span></div>
            <div class="input-group">
                <input type="text" name="bchcd" class="input-field" th:field="*{bchcd}" placeholder="例:001" required>
                <div th:if="${#fields.hasErrors('bchcd')}" style="color: red; font-size: 14px; margin-top: 5px;">
                    <span th:errors="*{bchcd}"></span>
                </div>
            </div>
        </div>

        <!-- 預金種別字段 -->
        <div class="form-group">
            <div class="label">預金種別<span><img src="/images/icon_required.png" alt=""></span></div>
            <div class="input-group">
                <div class="radio-group">
                    <div class="radio-option">
                        <input type="radio" id="depositType1" name="ykn" value="0"
                               th:field="*{ykn}"
                               class="radio-button" required>
                        <label for="depositType1" class="radio-label">普通預金</label>
                    </div>
                    <div class="radio-option">
                        <input type="radio" id="depositType2" name="ykn" value="1"
                               th:field="*{ykn}"
                               class="radio-button" required>
                        <label for="depositType2" class="radio-label">当座</label>
                    </div>
                </div>
                <div th:if="${#fields.hasErrors('ykn')}" style="color: red; font-size: 14px; margin-top: 5px;">
                    <span th:errors="*{ykn}"></span>
                </div>
            </div>
        </div>

        <!-- 口座番号字段 -->
        <div class="form-group">
            <div class="label">口座番号<span><img src="/images/icon_required.png" alt=""></span></div>
            <div class="input-group">
                <input type="text" name="actcd" class="input-field"
                       th:field="*{actcd}"
                       placeholder="例:1234567" required>
                <div th:if="${#fields.hasErrors('actcd')}" style="color: red; font-size: 14px; margin-top: 5px;">
                    <span th:errors="*{actcd}"></span>
                </div>
            </div>
        </div>

        <!-- 口座名義人字段 -->
        <div class="form-group">
            <div class="label">口座名義人<span><img src="/images/icon_required.png" alt=""></span></div>
            <div class="input-group">
                <input type="text" name="actnae" th:field="*{actnae}" class="input-field" placeholder="例:ヤマダ タロウ" required>
                <div class="note">・このカードの本人名義と同じでお記載ください。<br>
                    ・15文字以内で入力してください。</div>
                <div th:if="${#fields.hasErrors('actnae')}" style="color: red; font-size: 14px; margin-top: 5px;">
                    <span th:errors="*{actnae}"></span>
                </div>
            </div>
        </div>
        <!-- 一个按钮 -->
        <div style="text-align: center; margin-top: 20px;">

            <button type="submit" class="button-next">次へ進む</button>
        </div>
    </form>



    <!-- 居中显示版权信息 -->
    <div class="container">
        <p style="text-align: center;">Copyright © H · All Rights Reserved ·</p>
    </div>

</div>
</div>

</body>


</html>